"Delay is natural to a writer. He is like a surfer—he bides his time. Waits for the perfect wave on which to ride in. He waits for the surge (of emotion? of strength? of courage?) that will carry him along." (E.B. White, The Paris Review Interviews, 1969)

3.23.2010

Written by Dr. Manoj Jain, a Memphis, Tennessee-based infectious disease physician, adjunct assistant professor at Rollins School of Public Health at Emory University and medical director at Tennessee's Quality Improvement Organizations:

Last week, I saw a 55-year-old truck driver who pleaded with me to discharge him from the hospital even though his face and scalp still bore clear signs of an active staph infection. For a decade he has had recurrent staph infections exacerbated by diabetes -- yet could not afford insulin or a doctor because he lacked medical insurance. Now he begs me to let him leave, so that he will not go bankrupt from his medical bills.I turn to his wife who says, "I am lucky. I have metastatic breast cancer, and I am covered by Medicare."One of every 10 patients I see do not have health insurance.I see the uninsured patients, but then make up for my losses by increasing my charges to all my patients. The cycle continues: Insurers increase premiums, choking small businesses that then drop health coverage for their employees, leading more uninsured to come to my practice.Not providing insurance is not free; the annual health care expenditure for an uninsured adult is $1,800, according to a Kaiser Foundation study in 2004.And there is a downside to having nearly 50 million uninsured people in America. I look them in the eye, and I know this for a fact. They will die sooner. In my opinion, lack of health insurance is a chronic illness.The burden of this disease is most apparent among people between the ages of 54 to 65. A 2004 Health Affairs study found that lack of insurance accounts for 13,000 lives lost per year, making lack of insurance the third leading cause of death for this group, after heart disease and cancer. If we do nothing to address this problem, by 2015 lack of insurance will account for 30,000 deaths annually in just this age group.In all fairness the present health system provides some care for the uninsured. President Bush was technically accurate when he said in July 2007, "People have access to health care in America. After all, you just go to an emergency room."But the distinction between an acute illness -- the kind that sends you to the emergency room -- and chronic disease is artificial. For example, each year, diabetes, a chronic disease, causes 20,000 Americans to go blind, 45,000 Americans to have kidney failure and 45,000 Americans to lose a limb. Lack of health insurance is the same -- a chronic illness causing recurrent acute illnesses.I want to lean over and shake my uninsured patients and scream, "Be a Rosa Parks. Demand health care as a right -- just as others before you have marched for civil rights and human rights."The uninsured have become second-class citizens. Nearly 30 million of them, who are the working poor, are unable to afford health insurance, and there is no one to unite them and voice their concerns.The Rev. Martin Luther King Jr. was not silent about people's right to health care. "Of all the forms of inequality," he said, "injustice in health care is the most shocking and inhumane." He was speaking, I believe, of both acute care and chronic care.